Provider Demographics
NPI: | 1174670616 |
---|---|
Name: | TUTTLE, LAURA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | LAURA |
Middle Name: | |
Last Name: | TUTTLE |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2101 EAST JEFFERSON STREET |
Mailing Address - Street 2: | PPQA MEDICARE COMPLIANCE UNIT 6 WEST ATTN THERESA BROOK |
Mailing Address - City: | ROCKVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20832-4908 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-816-6660 |
Mailing Address - Fax: | 301-816-6308 |
Practice Address - Street 1: | 8550 LEE HIGHWAY |
Practice Address - Street 2: | SUITE 300 |
Practice Address - City: | FAIRFAX |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22031-1517 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-207-2864 |
Practice Address - Fax: | 703-207-2838 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-05 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101231139 | 2084P0800X |
DC | MD32799 | 2084P0800X |
MD | D57844 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
H82150 | Medicare UPIN | ||
011399M92 | Medicare ID - Type Unspecified |